Irritable Bowel Syndrome Treatments
| IRRITABLE BOWEL SYNDROME TREATMENTS | |||||
|---|---|---|---|---|---|
| Generic | Brand | Strength | Form | Usual Dose | |
| 5-HT3 RECEPTOR ANTAGONIST | |||||
| alosetron HCl | Lotronex | Rx | 0.5mg, 1mg | tabs | Adults: 0.5mg twice daily; may increase to 1mg twice daily after 4wks if needed. If constipation occurs, discontinue until constipation resolves, then restart at 0.5mg once daily. Discontinue if constipation recurs or inadequate symptom control after 4wks of treatment at 1mg twice daily. Children: Not recommended. |
| ANTICHOLINERGICS | |||||
| dicyclomine HCl | — | Rx | 10mg/5mL | syrup | Adults: Initially 20mg 4 times daily; may increase to 40mg 4 times daily after 1wk if tolerated. Discontinue if not effective within 2wks or daily doses ≥80mg are not tolerated. Inj: Give by IM route only. 10−20mg four times daily for max 1−2 days when oral therapy is not feasible. Children: <6mos: Contraindicated. ≥6mos: Consult manufacturer. |
| Bentyl | 10mg | caps | |||
| 20mg | tabs | ||||
| Bentyl Injection | 10mg/mL | inj | |||
| hyoscyamine sulfate |
— | Rx | 0.125mg/ mL |
liq drops1,3 | Adults: 1−2mL every 4hrs or as needed; max 12mL/day. Children: 3.4kg: 4 drops. 5kg: 5 drops. 7kg: 6 drops. 10kg: 8 drops. 2−12yrs: 0.25−1mL; max 6mL/day. All: Every 4hrs or as needed. |
| Levbid | Rx | 0.375mg | ext-rel scored tabs | Adults: 1−2 tabs every 12hrs; max 4 tabs/day Children: Not recommended. |
|
| Levsin | Rx | 0.125mg | scored tabs | Adults: 1−2 tabs or 5−10mL every 4hrs or as needed; max 12 tabs or 60mL daily. Children: Infants <10kg: use drops |
|
| Levsin/ SL |
Rx | 0.125mg | SL scored tabs2 | Adults: 1−2 tabs every 4hrs or as needed; max 12 tabs/day. Children: <2yrs: Not recommended. ≥2yrs: ½−1 tab every 4hrs or as needed; max 6 tabs/day. |
|
| Nulev | Rx | 0.125mg | chew– able melt tabs |
Adults and Children: <2yrs: Not recommended. 2−12yrs: ½−1 tab every 4hrs or as needed; max 6 tabs/day. ≥12yrs: 1−2 tabs every 4hrs or as needed; max 12 tabs/day. | |
| BARBITURATE + ANTICHOLINERGICS | |||||
| phenobarbital/ hyoscyamine sulfate/ atropine sulfate/ scopolamine HBr |
Donnatal Elixir | Rx | 16.2mg/ 0.1037mg/ 0.0194mg/ 0.0065mg per 5mL |
liq1,4 | Adults: 5−10mL 3−4 times daily. Children: <10lb (4.5kg): Not recommended. 10lb (4.5kg): Initially 0.5mL every 4hrs or 0.75mL every 6hrs. 20lb (9.1kg): 1mL every 4hrs or 1.5mL every 6hrs. 30lb (13.6kg): 1.5mL every 4hrs or 2mL every 6hrs. 50lb (22.7kg): 2.5mL every 4hrs or 3.75mL every 6hrs. 75lb (34kg): 3.75mL every 4hrs or 5mL every 6hrs. 100lb (45.4kg): 5mL every 4hrs or 7.5mL every 6hrs. |
| Donnatal Tablets | Rx | 16.2mg/ 0.1037mg/ 0.0194mg/ 0.0065mg | tabs | Adults: 1−2 tabs 3−4 times daily Children: Not recommended. |
|
| BENZODIAZEPINE + ANTICHOLINERGIC | |||||
| chlordiazep– oxide HCl/ clidinium bromide |
Librax | CIV | 5mg/ 2.5mg |
caps | Adults: Individualize. Usually 1−2 caps 3−4 times daily before meals and at bedtime. Elderly or debilitated: max 2 caps daily initially, then may increase gradually. Children: Not established. |
| GI MOTILITY ENHANCER (CHLORIDE CHANNEL ACTIVATOR) |
|||||
| lubiprostone | Amitiza | Rx | 8mcg, 24mcg | caps | ≥18yrs: Take with food and water. IBS-C: 8mcg twice daily. Severe hepatic impairment (Child-Pugh Class C): initially 8mcg once daily; if tolerated and inadequate response, may escalate to full dose; monitor. <18yrs: Not established. |
| GUANLYATE CYCLASE-C AGONIST | |||||
| linaclotide | Linzess | Rx | 72mcg, 145mcg, 290mcg | caps | Adults: Take on empty stomach, at least 30mins before first meal of the day. IBS-C: 290mcg once daily. Children: <6yrs: Contraindicated. 6−17yrs: Avoid. |
| plecanatide | Trulance | Rx | 3mg | tabs | ≥18yrs: IBS-C: 3mg once daily. <18yrs: Not established. |
| MU-OPIOID RECEPTOR AGONIST | |||||
| eluxadoline | Viberzi | CIV | 75mg, 100mg | tabs | Adults: Take with food. IBS-D: 100mg twice daily. Mild or moderate hepatic impairment, concomitant OATP1B1 inhibitors, intolerance to 100mg: 75mg twice daily. Children: Not established. |
| RIFAMYCIN | |||||
| rifaximin | Xifaxan | Rx | 550mg | tabs | ≥18yrs: IBS-D: 550mg three times daily for 14 days. Recurrent episodes: can retreat up to two times with the same dose. <18yrs: Not established. |
| NOTES | |||||
|
Key: IBS-C = irritable bowel syndrome with constipation; IBS-D = irritable bowel syndrome with diarrhea; ODT = orally disintegrating tablets; SL = sublingual 1contains alcohol; 2dye-free, peppermint flavor; 3orange flavor; 4grape flavor (Rev. 9/2018) |
|||||
This article originally appeared on MPR
